Significant Interaction Effect Of Group Research Articles

O4.3. SHARED AND DIFFERENTIAL NEUROCOGNITIVE EFFECTS COMPARING HIGH-INTENSITY INTERVAL TRAINING AND ACTIVE VIDEO-GAMING IN SCHIZOPHRENIA – RESULTS FROM AN RCT

BackgroundStudies on the efficiency and efficacy of aerobic exercise (AE) as a neurocognitive intervention in schizophrenia are promising, but there is a need for larger and well-designed randomized controlled trials (RCT) to draw more certain conclusions. The aim of this RCT was to study the effect of high-intensity interval training (HIIT), on neurocognitive functions in schizophrenia. A comparison group performed active video-gaming (AVG) using Nintendo WII sport. We hypothesized some effect in both groups, but anticipated that the effect of HIIT would reach beyond AVG. However, in recent studies AVG interventions with perceptual and motor-coordination demands were found to have neurocognitive effects equivalent to AE, challenging our hypothesis and adding new relevance to our study. To our knowledge, this is the first study to compare the effects of HIIT and AVG on neurocognition in schizophrenia.MethodsThe current study was a single-blinded RCT. Eighty-two participants (61% males, median age 32 (24.3)) diagnosed with schizophrenia were recruited from outpatient clinics at Vestfold Hospital Trust and randomly allocated to HIIT (n=43) or AVG (n=39). Both interventions consisted of 45 minutes supervised sessions two times per week for 12 weeks. The primary outcome neurocognition was measured with the MATRICS consensus cognitive battery by blinded assessors at baseline, post-intervention and follow-up. In sum 88% were protocol-compliant and attrition rate was 30.5%, resulting in 65% protocol-compliant study-completers (HIIT n=25/AVG n=28).Intervention effects were estimated using repeated linear mixed model analysis (LMM): Intention-to-treat (ITT) analyses of all randomized participants and per-protocol (PP) analyses of protocol-compliant study-completing participants. Per-protocol between-group effect sizes (Cohen’s d) and within-group pretest-posttest effect sizes were calculated.ResultsWe present post-intervention results. In the between-group analysis (ITT and PP) there was a main effect of time (EST 2.71, 95% CI: 1.45–3.98, p <.001), but no significant interaction effect of group and time (EST 0.36, 95% CI: -1.45–2.17, p=.696), for the neurocognitive composite T-score. The same pattern of results was found in the subdomains, indicating an increase in functioning over time for both groups on several subdomains. Per-protocol effect-sizes indicated a small to medium effect on verbal learning favoring HIIT (Cohen’s d =.46).Within-group analysis (PP) and pre-post effect sizes (PP) indicated small effects from both interventions on the neurocognitive composite score and the subdomains attention and working memory. There was a small effect on speed from HIIT. In the learning domain, HIIT had significant medium effect on verbal learning while AVG had a significant small effect on visual learning.DiscussionContrary to our hypothesis, the main analyses did not indicate superiority of HIIT compared to AVG on neurocognitive functions. Despite this, effect sizes indicated a small/moderate effect on verbal learning favoring HIIT.Within-group analysis showed increase in the neurocognitive composite score and the subdomains attention and working memory following both interventions. There was a small increase in speed following HIIT. Differential effects within the learning domain as indicated by increased verbal learning following HIIT and increased visual learning following AVG was unexpected, but replicate studies showing differential neurocognitive effects from different training modes. Our results show shared and differential positive effects from the two exercise modes HIIT and AVG on neurocognition. Both show potential as clinical interventions targeting neurocognition in schizophrenia.

Neurodynamic sliders promote flexibility in tight hamstring syndrome

ABSTRACT Hamstring injury prevention puts emphasis on optimizing the muscle's strength–length relationship. To assure appropriate muscle length, flexibility training is imperative. As neurodynamics play an important role herein, the goal of this study was to explore the intervention effect of home-based neurodynamic slider program on hamstring flexibility. Fifty physically active male subjects were randomly assigned to either performing a neurodynamic sliding technique (3 × 20 reps) or a static stretching protocol (3 × 30″) on a daily basis for a 6-week period. Hamstring flexibility was assessed by means of the Straight Leg Raise at baseline, immediately after the intervention and after 4 weeks follow up. There was no between group baseline difference in hamstring flexibility. The repeated measure ANOVA showed a significant interaction effect for group × time (p < 0.001). Independent sample t-test showed a significantly higher increase in flexibility gain in the neurodynamic group immediately after the intervention (p < 0.001), as well as at 4 weeks retention analysis (p = 0.001) compared to the static stretch group. In conclusion, neurodynamic sliders might be more efficient than regular static stretching in affecting hamstring flexibility in the long run.

Effects of auditory-motor synchronization on 400-m sprint performance: An applied study

There is a conspicuous dearth of empirical research regarding the ergogenic and psychological effects of synchronous music when applied in a sports training context. The main purpose of this longitudinal intervention study was to investigate the ergogenic and psychological effects of synchronous music applied over a one-month period of speed endurance training. Twelve participants (six women and six men; 21.1 ± 1.7 years) were randomly assigned to either an experimental group (sprint training coordinated with synchronous music) or a control group (conventional sprint training). Immediately after each training session and each time trial, the Feeling Scale, CR-10 Rating of Perceived Exertion Scale, and Physical Activity Enjoyment Scale were administered to each participant. No significant interaction effect of Group × Time for Rating of Perceived Exertion ( p = .898) or Physical Activity Enjoyment Scale ( p = .411) was identified during the training sessions. A significant Group × Time interaction was identified for Feeling Scale scores ( p = .007). Nonetheless, following Bonferroni adjustment for pairwise comparisons, the between-group differences in Feeling Scale scores did not reach significance. No significant interaction effect of Group × Time or main effect of group was identified for sprint performance, although the latter effect was associated with a large effect size (ηp2 = 0.35). Experimental group participants executed the 400-m time trials 5.07% faster than control group participants. This finding is noteworthy from an applied perspective, given the potential ergogenic effects associated with auditory-motor synchronization.

Fitness-Dependent Effect of Acute Aerobic Exercise on Executive Function.

Cognitive gains are reported to be induced by acute aerobic exercise, but the role of fitness in the effect of acute aerobic exercise on executive function remains unknown. Therefore, we aimed to examine the effect of fitness on acute exercise-induced changes in executive function from neural mechanism approach. Twenty-four female college students were assigned to high-fitness or low-fitness groups based on their cardiovascular fitness level, and then underwent functional magnetic resonance imaging while performing N-back tasks before and after 30 min of acute exercise. The behavioral results revealed significant interaction effects of group by time in the 0-back and 1-back tasks, but not in the 2-back task. The accuracy was significantly higher in the high-fitness group than in the low-fitness group before exercise in the 1-back and 2-back tasks. At the neural level, significant interaction effects of group by time were observed in all tasks. The 0-back and 1-back tasks activated the right cerebellum while the 2-back task activated subcortical regions. Our findings suggest that fitness moderates the effect of aerobic exercise on cognitive function, and provide the first neural evidence to support the influence of fitness on exercise-induced cognitive performance.

Internet-delivered psychological treatment for patients with health anxiety: Results from a randomized, controlled trial

Self-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety.Data were collected from a randomized controlled trial where participants with SHA were allocated to 12 weeks of exposure-based CBT (n = 99) for SHA or to a no treatment control condition (n = 33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase.Linear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z = 2.69, p = 0.007). The controlled effect size was moderately large (d = 0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH.12 weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.

Fostering the X-Factor in Pakistan’s university students

Possessing the X-Factor makes one more interesting, valuable, and unique than the rest. Based on a sample of 427 bachelor’s students, results of Study 1 supported the psychometric integrity of an X-Factor scale derived from various theoretical perspectives. Study 2 was a positive psychology strengths intervention, which entailed developing the X-Factor in 200 bachelor’s students (50 students randomly allocated to four groups; one untreated control and three experimental groups). The three interventions (individual, pair, and small group work) succeeded in developing the X-Factor in bachelor’s students, as indicated by the significant interaction effects of group and time of measurement (Pretest-Posttest-Follow-up test) on scores related to the X-Factor and its dimensions/subscales (self-insight, personal magnetism, self-determination, self-discipline, catalytic learning ability, and optimism). To examine the relative difference in the effect of the interventions, three sets of analysis of effect sizes were undertaken. The first set of analysis revealed that individual work was comparatively more suitable for enhancing the total X-Factor as well as self-determination, self-discipline, and optimism in university students. The second showed that pair work was comparatively more appropriate for improving self-insight and catalytic learning capability, whereas, the third demonstrated that small group work was more fitting for developing personal magnetism. Results have potential implications for education administrators, faculty members, student affairs practitioners, and positive psychology practitioners/facilitators. Researchers may use the valid and reliable scale in various innovative contexts to evaluate the potential of the X-Factor.

Dendrite complexity of the posterior cingulate cortex as a substrate for recovery from post-stroke depression: A pilot study

The neural basis of recovery from a depressive state remains poorly understood. The main purpose of this study was to determine the neural basis of vulnerability/resilience to depression in stroke patients in terms of changes in regional microstructure. The study included 20 individuals with acute ischaemic stroke. Symptoms of depression were assessed, and the intraneurite volume fraction and neurite orientation-dispersion index (ODI) were evaluated by a multi-shell diffusion imaging and neurite-orientation dispersion and density imaging model. Patients underwent follow-up examinations after 2 months and were classified into depression improvement and depression deterioration groups. A significant interaction effect of group × time on the ODI was shown by voxel-based analysis in the posterior cingulate cortex (PCC). The ODI change in the PCC was negatively correlated with the change in the depression scale scores at the 2-month time point. The increase in ODI in the PCC that occurred during the 2-month interval was thought to be associated with decreased depressive symptom scores. As the ODI represents the pattern of sprawling dendrite progression, our findings indicate that the dendritic complexity of the PCC is a substrate for recovery in individuals who experienced post-stroke psychosocial and biological stress.

Neural Activity During Mental Rotation in Deaf Signers: The Influence of Long-Term Sign Language Experience.

Mental rotation is the brain's visuospatial understanding of what objects are and where they belong. Previous research indicated that deaf signers showed behavioral enhancement for nonlinguistic visual tasks, including mental rotation. In this study, we investigated the neural difference of mental rotation processing between deaf signers and hearing nonsigners using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI). The participants performed a block-designed experiment, consisting of alternating blocks of comparison and rotation periods, separated by a baseline or fixation period. Mental rotation tasks were performed using three-dimensional figures. fMRI images were acquired during the entire experiment, and the fMRI data were analyzed with Analysis of Functional NeuroImages. A factorial design analysis of variance was designed for fMRI analyses. The differences of activation were analyzed for the main effects of group and task, as well as for the interaction of group by task. The study showed differences in activated areas between deaf signers and hearing nonsigners on the mental rotation of three-dimensional figures. Subtracting activations of fixation from activations of rotation, both groups showed consistent activation in bilateral occipital lobe, bilateral parietal lobe, and bilateral posterior temporal lobe. There were different main effects of task (rotation versus comparison) with significant activation clusters in the bilateral precuneus, the right middle frontal gyrus, the bilateral medial frontal gyrus, the right interior frontal gyrus, the right superior frontal gyrus, the right anterior cingulate, and the bilateral posterior cingulate. There were significant interaction effects of group by task in the bilateral anterior cingulate, the right inferior frontal gyrus, the left superior frontal gyrus, the left posterior cingulate, the left middle temporal gyrus, and the right inferior parietal lobe. In simple effects of deaf and hearing groups with rotation minus comparison, deaf signers mainly showed activity in the right hemisphere, while hearing nonsigners showed bilateral activity. In the simple effects of rotation task, decreased activities were shown for deaf signers compared with hearing nonsigners throughout several regions, including the bilateral parahippocampal gyrus, the left posterior cingulate cortex, the right anterior cingulate cortex, and the right inferior parietal lobe. Decreased activations in several brain regions of deaf signers when compared to hearing nonsigners reflected increased neural efficiency and a precise functional circuitry, which was generated through long-term experience with sign language processing. In addition, we inferred tentatively that there may be a lateralization pattern to the right hemisphere for deaf signers when performing mental rotation tasks.

The Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Heart Rate Variability in Physically Inactive Adults.

Physically inactive adults are prevalent worldwide. This study compared the effects of short-term high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on heart rate variability (HRV) in physically inactive adults as a preliminary study. Thirteen physically inactive male adults (27.5 ± 3.80 years) were randomly assigned to HIIT (N = 7) or MICT (N = 6). The HIIT program consisted of 20 min of interval training with cycling to rest ratio of 10/50 s at ≥90% HRpeak, while the MICT program consisted of 40 min of continuous cycling at 60–75% HRpeak. Both groups completed eight sessions of training within two weeks. Time and frequency domains of HRV were measured for 20 min with Actiwave-Cardio monitor (CamNtech, UK). The number of R-R interval and inter-beat interval (IBI) were significantly improved (p < 0.05) in both HIIT and MICT programs following eight sessions of training. A significant interaction effect for group by time was found in the lnLF/HF ratio (p < 0.05) where it was only improved in the HIIT group from pre- to post-test. The HIIT program is superior to MICT in improving HRV in physically inactive adults. The HIIT program can be applied as a time-efficient program for improving cardiac-autoregulation.

Effect of a Positive Photo Appreciation Program on Depressive Mood in Older Adults: A Pilot Randomized Controlled Trial.

Safer and more effective programs are required to cope with an increasing number of older people with depression. Hence, we developed the Positive Photo Appreciation (PPA) program. A three-month pilot randomized controlled trial was conducted with healthy Japanese individuals aged 65–84 years, assigned to a PPA group (n = 28) or Photo Correspondence Education (PCE) (control group) (n = 27). We used the Center for Epidemiologic Studies Depression Scale (CES-D) score as the primary outcome measure. Secondary outcome measures, among others, were cognitive function and positive emotion. Data collected at baseline and post-intervention were analyzed using a linear mixed-effect model. Over 80% of the participants in the PPA group completed and were satisfied with the program. Compared with the PCE group, the CES-D score in the PPA group significantly improved (main effect of group: t = −4.30, p < 0.001; interaction effect of group by time: t = 4.39, p < 0.001), with an effect size of d = 1.23. Additionally, a positive significant interaction effect of group by time was found in the Positive and Negative Affect Schedule (t = −2.33, p = 0.024). The PPA program might be promising for mitigating depressive mood in older adults.

The effects of a video-based education in women with newly diagnosed breast cancer in Singapore

The purpose of this study was to evaluate the impact of an educational video among women who were newly diagnosed with breast cancer on knowledge, anxiety, and satisfaction with their surgical decision. A pre-post-test design was used to evaluate knowledge, anxiety, and satisfaction levels with decision-making regarding surgery among women with breast cancer. A purposive sampling strategy was implemented to compare outcomes of newly diagnosed breast cancer women who received standard of care that included breast care nurse counseling sessions and written materials to women who received standard of care plus a supplement educational video. Knowledge and anxiety scores were collected at baseline and 2weeks post-operatively. Satisfaction with decision (SWD) on the nature of surgery was gathered 2weeks after surgery. Sixty-two subjects were recruited in a Singapore tertiary cancer center with a cohort of 32 women in the non-video group and 30 women in the video group. There was a statistically significant interaction effect of group and time (p = .008), wherein knowledge increased for both groups, although the increase was steeper for the video group. Both groups had significantly lower anxiety at post-implementation compared to pre-implementation (p < .001). There were no differences in SWD scores in both groups. Use of an additional video-based education significantly increased breast cancer knowledge levels among women in the educational video group. Nurses and healthcare professionals should focus on identifying individual informational needs based on surgical options to provide personalize care and transfer the necessary knowledge in empowering woman's decision-making process on her nature of breast surgery.

Improvement in Hand Trajectory of Reaching Movements by Error-Augmentation.

The purpose of this study was to investigate whether adaptive responses to error-augmentation force fields, would decrease the trajectory errors in hand-reaching movements in multiple directions in healthy individuals. The study was conducted, as a randomized controlled trial, in 41 healthy subjects. The study group trained on a 3D robotic system, applying error-augmenting forces on the hand during the execution of tasks. The control group carried out the same protocol in null-field conditions. A mixed-model ANOVA was implemented to investigate the interaction between groups and time, and changes in outcome measures within groups. The findings were that there was a significant interaction effect for group × time in terms of the magnitude of movement errors across game-sets. The trajectory error of the study group significantly decreased from 0.035±0.013m at baseline to 0.029±0.011m at a follow-up, which amounted to a 14.8% improvement. The degree of movement errors were not significantly changed within a game-set. We conclude that practicing hand-reaching movement in multiple random directions, using the error-augmentation technique, decreases the deviation of the hand trajectory from a straight line. However, this type of training prevents the generalizability of adaptation between consecutive reaching movements. Further studies should investigate the feasibility of this training method for rehabilitation of post-stroke individuals.

The effect of modified catheter balloon dilatation therapy on corticobulbar excitability in dysphagic brainstem stroke patients

Objective To explore the effect of the modified balloon dilatation on excitability of the submental swallowing muscle and its relationship with swallowing function of dysphagic patients with brainstem stroke. Methods Thirty unilateral brainstem stroke patients with upper esophageal sphincter (UES) dysfunction were recruited and randomly divided into a dilatation group and a control group, each of 15. The control group was given the routine swallowing therapy twice daily, while the dilatation group was provided one routine swallowing treatment plus a modified balloon dilatation daily. The treatment lasted 3 weeks, 30min per day and 5 days per week. Both groups were evaluated using the bilateral submental motor evoked potentials (SMEPs), penetration-aspiration scale (PAS) and functional oral intake scale (FOIS) before and after treatment. Results Repeated analysis of variance showed that there was significant interaction effect of group, time on SMEPs. The MEPs of the affected submental muscle increased significantly in both groups after treatment (P<0.01), but only the amplitude of SMEP of the affected submental muscles in the dilatation group was higher than that of the control group after treatment (P<0.05). In the dilatation group, the average FOIS score increased significantly (P<0.01), while the average PAS score decreased significantly after the treatment (P<0.05). An increase of amplitude of the affected SMEP was strongly correlated with the improvement in the average PAS score (P<0.01, r=0.815), but weakly correlated with the average FOIS score (P=0.02, r=0.43). Conclusion The modified balloon dilatation therapy can increase the excitability of the cortical-affected lateral brainstem-swallowing muscle pathway in patients with unilateral brainstem stroke, which might be more correlated with improvement in swallowing safety. Key words: Brainstem stroke; Dysphagia; Balloon dilatation therapy; Neuroplasticity

Internet-based affect-focused psychodynamic therapy for social anxiety disorder: A randomized controlled trial with 2-year follow-up.

Social anxiety disorder (SAD) is associated with considerable individual suffering and societal costs. Although there is ample evidence for the efficacy of cognitive behavior therapy, recent studies suggest psychodynamic therapy may also be effective in treating SAD. Furthermore, Internet-based psychodynamic therapy (IPDT) has shown promising results for addressing mixed depression and anxiety disorders. However, no study has yet investigated the effects of IPDT specifically for SAD. This paper describes a randomized controlled trial testing the efficacy of a 10-week, affect-focused IPDT protocol for SAD, compared with a wait-list control group. Long-term effects were also estimated by collecting follow-up data, 6, 12, and 24 months after the end of therapy. A total of 72 individuals meeting diagnostic criteria for DSM-IV social anxiety disorder were included. The primary outcome was the self-report version of Liebowitz Social Anxiety Scale. Mixed model analyses using the full intention-to-treat sample revealed a significant interaction effect of group and time, suggesting a larger effect in the treatment group than in the wait-list control. A between-group effect size Cohen's d = 1.05 (95% [CI]: [0.62, 1.53]) was observed at termination. Treatment gains were maintained at the 2-year follow-up, as symptom levels in the treated group continued to decrease significantly. The findings suggest that Internet-based affect-focused psychodynamic therapy is a promising treatment for social anxiety disorder. (PsycINFO Database Record

Increased resting-state global functional connectivity density of default mode network in schizophrenia subjects treated with electroconvulsive therapy

Modified electroconvulsive therapy (MECT) has been widely applied to help treat schizophrenia patients who are treatment-resistant to pharmaceutical therapy. Although the technique is increasingly prevalent, the underlying neural mechanisms have not been well clarified. We conducted a longitudinal study to investigate the alteration of global functional connectivity density (gFCD) in schizophrenia patients undergoing MECT using resting state fMRI (functional magnetic resonance imaging). Two groups of schizophrenia inpatients were recruited. One group received a four-week MECT together with antipsychotic drugs (ECT+Drug, n=21); the other group only received antipsychotic drugs (Drug, n=21). Both groups were compared to a sample of healthy controls (HC, n=23). fMRI scans were obtained from the schizophrenia patients twice at baseline (t1) and after 4-week treatment (t2), and from healthy controls at baseline. gFCD was computed using resting state fMRI. Repeated ANCOVA showed a significant interaction effect of group×time in the schizophrenia patients in left precuneus (Pcu), ventral medial prefrontal cortex (vMPFC), and dorsal medial prefrontal cortex (dMPFC) (GRF-corrected P<0.05), which are mainly located within the default mode network (DMN). Post-hoc analysis revealed that compared with baseline (t1), an increased gFCD was found in the ECT+Drug group in the dMPFC (t=3.87, p=0.00095), vMPFC (t=3.95, p=0.00079) and left Pcu (t=3.33, p=0.0034), but no significant effect was identified in the Drug group. The results suggested that increased global functional connectivity density within the DMN might be one important neural mechanism of MECT in schizophrenia.

A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods

Fully automated self-help interventions can serve as highly cost-effective mental health promotion tools for massive amounts of people. However, these interventions are often characterised by poor adherence. One way to address this problem is to mimic therapy support by a conversational agent. The objectives of this study were to assess the effectiveness and adherence of a smartphone app, delivering strategies used in positive psychology and CBT interventions via an automated chatbot (Shim) for a non-clinical population — as well as to explore participants' views and experiences of interacting with this chatbot. A total of 28 participants were randomized to either receive the chatbot intervention (n=14) or to a wait-list control group (n=14). Findings revealed that participants who adhered to the intervention (n=13) showed significant interaction effects of group and time on psychological well-being (FS) and perceived stress (PSS-10) compared to the wait-list control group, with small to large between effect sizes (Cohen's d range 0.14–1.06). Also, the participants showed high engagement during the 2-week long intervention, with an average open app ratio of 17.71 times for the whole period. This is higher compared to other studies on fully automated interventions claiming to be highly engaging, such as Woebot and the Panoply app. The qualitative data revealed sub-themes which, to our knowledge, have not been found previously, such as the moderating format of the chatbot. The results of this study, in particular the good adherence rate, validated the usefulness of replicating this study in the future with a larger sample size and an active control group. This is important, as the search for fully automated, yet highly engaging and effective digital self-help interventions for promoting mental health is crucial for the public health.

The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial

ObjectiveSelf-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety. MethodsData were collected from a randomized controlled trial where participants with SHA were allocated to 12weeks of exposure-based CBT (n=99) for SHA or to a no treatment control condition (n=33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase. ResultsLinear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z=2.69, p=0.007). The controlled effect size was moderately large (d=0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH. Conclusions12weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.

The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.

A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. However, the specific benefits of diaphragmatic breathing on mental health remain largely unknown. The present study aimed to investigate the effect of diaphragmatic breathing on cognition, affect, and cortisol responses to stress. Forty participants were randomly assigned to either a breathing intervention group (BIG) or a control group (CG). The BIG received intensive training for 20 sessions, implemented over 8 weeks, employing a real-time feedback device, and an average respiratory rate of 4 breaths/min, while the CG did not receive this treatment. All participants completed pre- and post-tests of sustained attention and affect. Additionally, pre-test and post-test salivary cortisol concentrations were determined in both groups. The findings suggested that the BIG showed a significant decrease in negative affect after intervention, compared to baseline. In the diaphragmatic breathing condition, there was a significant interaction effect of group by time on sustained attention, whereby the BIG showed significantly increased sustained attention after training, compared to baseline. There was a significant interaction effect of group and time in the diaphragmatic breathing condition on cortisol levels, whereby the BIG had a significantly lower cortisol level after training, while the CG showed no significant change in cortisol levels. In conclusion, diaphragmatic breathing could improve sustained attention, affect, and cortisol levels. This study provided evidence demonstrating the effect of diaphragmatic breathing, a mind-body practice, on mental function, from a health psychology approach, which has important implications for health promotion in healthy individuals.

Effects of Intensive Short-Term Dynamic Psychotherapy on Depressive Symptoms and Executive Functioning in Major Depression.

This study examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) on depressive symptoms and executive functioning in patients with major depression. We examined pretest, posttest, and follow-up depression scores as well as pretest-posttest executive functioning scores between 16 participants receiving ISTDP and 16 allocated to wait-list control. Participants in each group were matched according to age, sex, and educational level. Mixed-models analyses demonstrated significant interaction effects of group and time on depression scores when the group ISTDP was compared with the wait-list control group; participants receiving ISTDP had significantly reduced depression severity both after treatment and at follow-up. Next, a series of hierarchical regression models demonstrated modest improvements on most tests of executive functioning in participants receiving ISTDP. Depressed patients receiving ISTDP show a sustained reduction in depression severity after treatment and after 12-month follow-up and improvements in executive functioning after treatment compared with a wait-list control.

Evaluation of individualized quality of life and illness perceptions in low back pain. A patient education cluster randomized controlled trial

ObjectiveTo evaluate the effect of a cognitive patient education intervention compared with usual care on secondary outcomes of individual quality of life and psychological outcomes of illness perceptions and pain catastrophizing in patients with low back pain. MethodsA pragmatic cluster randomized controlled trial in which 16 general practitioners (GPs) and 20 physiotherapists (PTs) in primary care were randomly assigned to provide either a cognitive patient education intervention or usual treatment. Patients were followed up at 4 weeks and 12 months after treatment. Linear mixed models were used with group, time, type of clinician and interaction effects of group*time as fixed effects. ResultsA total of 203 patients provided data at baseline, 86% responded at 4 weeks and 74% at 12 months. For all the outcome measures there was a statistically significant effect of time (p<0.001) and type of clinician (p<0.05) during the follow-up year. There was a significant interaction effect of group×time on illness perceptions (p=0.003), however not for the other outcome measures. ConclusionThe cognitive patient education intervention initiated a faster improvement in illness perceptions but not in the other outcomes. Practice implicationsA patient education intervention can be beneficial to improve illness perceptions, however more research is needed.